Digital mole monitoring

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 Author(s): Harald Kittler, Scott Menzies

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It has the following subchapters:

• Short Term Monitoring
• Long Term Monitoring

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Basic principle of digital dermoscopes

A hand-held dermatoscope is attached to a digital video camera. The camera is connected to a monitor, that displays the dermoscopic image in real time. A computer allows to capture and storage the images from the camera.

Digital dermoscopy can improve diagnostic sensitivity for early melanoma by identifying changes in lesions over time that indicate impending or incipient malignancy and it can reduce the number of biopsies of benign lesions that are biologically indolent (senescent, not changing).

Benefits of digital mole monitoring

• Simpler monitoring of lesions
• Images of the same lesion obtained at different points are easy to compare
• Enables to diagnose small, inconspicuous and featureless melanomas by detecting change over time
• Helpful for high risk individuals with multiple pigmented lesions
• Patient participation in the examination

Indications and contraindications

• Digital monitoring should be reserved for small and flat melanocytic lesions, that demonstrate no obvious clues to melanoma.
• Regardless of how one uses monitoring, knowing which lesions are unsafe to monitor is essential. Monitoring is performed on potential melanomas.
• Monitoring by digital monitoring is especially suitable for patients with multiple nevi. For these high risk patients, lesions to be monitored are selected randomly. It is recommended to evaluate and re-image as many lesions as possible at each consultation.
• When examining patients with multiple nevi, it is recommended to dispense with the documentation of melanocytic lesions that are smaller than 3mm in diameter.
• Nodular melanomas can grow rapidly even in the early stages of evolution. Nodular lesions that cannot be diagnosed as benign with absolute certainty must be excised at the initial consultation.

Interpretation of changes

Distinctions are made on the basis of changes in size, color and structure.

Changes in size

• Symmetrical: the shape of the lesions remains the same
• Asymmetrical: tha shape changes

Changes in color

• A pre-existing color (usually brown) appears lighter or darker
• A new color is seen

Changes in structure

• Disappearance of an existing pattern
• Appearance of a new pattern
• Presence of basic elements of a pattern in greater or reduced numbers (such as dots or clods)

Short Term Monitoring [1]

every three months or less
Is performed for lesions, that because of history of appearance, cannot be deemed benign with absolute certainty at the initial examination

Long Term Monitoring [2]

every six months to one year
Is mainly used for randomly selected lesions with no features to suggest malignancy, typically in patients with multiple nevi

Growing nevus or melanoma?

• Nevi stop growing at some time whereas melanomas do not.
• In adults, the proportion of nevi that show significant changes in the course of a year is less than 5%.
• Changes in color almost never occur in nevi. Significant structural changes are mainly observed in melanoma.
• Most of nevi do not change over one year. Monitoring over intervals longer than one year is not recommended.
• The longer the monitoring period, the more noticeable the changes are.

References

1. An Atlas of Dermoscopy, Second Edition. Marghoob A. et al. CRC Press; 2012.
2. Altamura, D., Avramidis, M. & Menzies, S.W., 2008, Assessment of the optimal interval for and sensitivity of short-term sequential digital dermoscopy moni- toring for the diagnosis of melanoma. Arch Dermatol, 144, 502–6.
3. Altamura, D., Zalaudek, I., Sera, F., et al., 2007, Dermoscopic changes in acral mela- nocytic nevi during digital follow-up. Arch Dermatol, 143, 1372–6.
4. Argenziano, G., Kittler, H., Ferrara, G., et al., 2010, Slow-growing melanoma: a dermoscopy follow-up study. Br J Dermatol, 162, 267–73.
5. Argenziano, G., Zalaudek, I. & Ferrara, G., 2007, Fast-growing and slow-growing melanomas. Arch Dermatol, 143, 802–3; author reply 803–4.
6. Banky, J.P., Kelly, J.W., English, D.R., Yeatman, J.M. & Dowling, J.P., 2005, Incidence of new and changed nevi and melanomas detected using baseline images and dermoscopy in patients at high risk for melanoma. Arch Dermatol, 141, 998–1006.
7. Bauer, J., Blum, A., Strohhäcker, U. & Garbe, C., 2005, Surveillance of patients at high risk for cutaneous malignant melanoma using digital dermoscopy. Br J Dermatol, 152, 87–92.
8. Dawid, M., Pehamberger, H., Wolff, K., Binder, M. & Kittler, H., 2002, Evaluation of the ability of patients to identify enlarging melanocytic nevi. Arch Dermatol, 138, 984–5.
9. Fuller, S.R., Bowen, G.M., Tanner, B., Florell, S.R. & Grossman, D., 2007, Digital dermoscopic monitoring of atypical nevi in patients at risk for melanoma. Dermatol Surg, 33, 1198–206; discussion 1205–6.
10. Haenssle, H.A., Krueger, U., Vente, C., et al., 2006, Results from an observational trial: digital epiluminescence microscopy follow-up of atypical nevi increases the sensitivity and the chance of success of conventional dermoscopy in detecting melanoma. J Invest Dermatol, 126, 980–5.
11. Kittler, H. & Binder, M., 2001, Risks and benefits of sequential imaging of melanocytic skin lesions in patients with multiple atypical nevi. Arch Dermatol, 137, 1590–5.
12. Kittler, H. & Binder, M., 2002, Follow-up of melanocytic skin lesions with digital dermoscopy: risks and benefits. Archives of Dermatology, 138, 1379.
13. Kittler, H., Guitera, P., Riedl, E., et al., 2006, Identification of clinically featureless incipient melanoma using sequential dermoscopy imaging. Arch Dermatol, 142,
14. 1113–19.
15. Kittler, H., Pehamberger, H., Wolff, K. & Binder, M., 2000a, Follow-up of melanocytic skin lesions with digital epiluminescence microscopy: patterns of modifications observed in early melanoma, atypical nevi, and common nevi. J Am Acad Dermatol, 43, 467–76.
16. Kittler, H., Seltenheim, M., Dawid, M., et al., 2000b, Frequency and characteristics of enlarging common melanocytic nevi. Arch Dermatol, 136, 316–20.
17. Menzies, S.W., Gutenev, A., Avramidis, M., Batrac, A. & McCarthy, W.H., 2001, Short-term digital surface microscopic monitoring of atypical or changing melanocytic lesions. Arch Dermatol, 137, 1583–9.
18. Robinson, J. & Nickoloff, B., 2004, Digital epiluminescence microscopy monitoring of high-risk patients. Arch Dermatol, 140, 49–56.
19. Schiffner, R., Schiffner-Rohe, J., Landthaler, M. & Stolz, W., 2003, Long-term dermoscopic follow-up of melanocytic naevi: clinical outcome and patient compliance. Br J Dermatol, 149, 79–86.
20. Terushkin, V., Dusza, S.W., Scope, A., et al., 2012, Changes observed in slow-growing melanomas during long-term dermoscopic monitoring. Br J Dermatol, 166, 1213–20.
21. Zalaudek, I., Karin, S., Marghoob, A., et al., 2011, Frequency of dermoscopic nevus subtypes by age and body site: a Cross-sectional Study. Arch Dermatol, 147, 663–70.